Belletrutti Paul J, DiMaio Christopher J, Gerdes Hans, Schattner Mark A
Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, P.O. Box 273, New York, NY 10065, USA.
J Gastrointest Cancer. 2011 Sep;42(3):137-42. doi: 10.1007/s12029-010-9175-7.
When endoscopic retrograde cholangiopancreatography (ERCP) is not possible due to duodenal obstruction, endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternate mode of biliary decompression. This study aims to determine the safety and outcomes of performing EUS-BD in such patients.
A retrospective review of our endoscopy procedure database was carried out to identify patients with malignant biliary obstruction and failed ERCP in whom EUS-BD was attempted.
Seven patients were identified. The technical success rate was 6/7 (86%). Four patients were treated with a choledochoduodenostomy; two had hepaticogastrostomies; drainage was not attempted in one due to unfavorable anatomy on EUS. In three patients, EUS-BD was performed immediately after unsuccessful ERCP as a single procedure. The initial choice of stent was plastic in two, self-expanding uncovered metal in two, and fully covered metal in two. The median follow-up was 15.5 weeks. There were no immediate complications. Bilirubin decreased in 5/6 (83%) and jaundice resolved in 4/6 (67%). Pruritus resolved in 4/4 (100%). Chemotherapy was restarted in 4/6 (67%). Reintervention due to stent blockage occurred twice. Both were converted to fully covered metal stents. No instances of stent migration were observed.
In our series, EUS-BD is a feasible, safe, and effective method of internal drainage in appropriately selected patients with biliary obstruction and unapproachable ampullae due to malignant duodenal obstruction. EUS-BD can be performed immediately after a failed ERCP under the same anesthesia. Covered metal stents may be preferred, but further study is required.
当因十二指肠梗阻无法进行内镜逆行胰胆管造影术（ERCP）时，内镜超声引导下胆道引流术（EUS-BD）已成为胆道减压的替代方式。本研究旨在确定在此类患者中进行EUS-BD的安全性和结局。
对我们的内镜手术数据库进行回顾性分析，以识别患有恶性胆道梗阻且ERCP失败并尝试进行EUS-BD的患者。
共识别出7例患者。技术成功率为6/7（86%）。4例患者接受了胆总管十二指肠吻合术；2例进行了肝胃吻合术；1例因EUS显示解剖结构不佳未尝试引流。3例患者在ERCP失败后立即作为单一手术进行了EUS-BD。最初选择的支架类型为2例塑料支架、2例自膨式裸金属支架和2例全覆膜金属支架。中位随访时间为15.5周。无即刻并发症。5/6（83%）的患者胆红素下降，4/6（67%）的患者黄疸消退。4/4（100%）的患者瘙痒缓解。4/6（67%）的患者重新开始化疗。因支架堵塞进行了两次再次干预，均更换为全覆膜金属支架。未观察到支架移位情况。
在我们的系列研究中，对于因恶性十二指肠梗阻导致胆道梗阻且无法接近壶腹的合适患者，EUS-BD是一种可行、安全且有效的内引流方法。EUS-BD可在ERCP失败后在同一麻醉下立即进行。覆膜金属支架可能更受青睐，但仍需进一步研究。
